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LOW LACTOSE DIET - MILK FREE DIET

What is a Low Lactose Diet ?

A milk free diet means not drinking milk, and avoiding all foods which contain milk or milk products. It is also advisable to avoid goat, sheep and buffalo milk and milk products, as they are very similar to cow’s milk. In some conditions it is only lactose (milk sugar) which needs to be avoided. Please use the following as guidelines only, until you see a dietitian.

What is a Low Lactose Diet used for ?

Some children and adults need to avoid milk products to which they have become allergic. A history of allergy usually runs in the family. The allergic reaction or intolerance can take many forms. Facial swelling, skin rashes, eczema, diarrhoea and vomiting are the most common. In addition, children may fail to thrive.. Many children will grow out of their allergy or intolerance by school age. However, if still sensitive by then, they are likely to remain intolerant of milk. Other reasons for a milk free diet include lactose intolerance following an attack of gastroenteritis, previously untreated coeliac disease and the permanent lactose intolerance due to inherited lactase deficiency. Lactase is an enzyme in the bowel wall which digests lactose. In transient lactose intolerance, lactase is not produced while there is illness in the gut, but is manufactured again once the gut has recovered. In inherited lactase deficiency, the ability to digest lactose is gradually lost over the first few years. However, most people with this disorder can continue to cope with some lactose in the diet. This type of lactase deficiency occurs only in certain races.

How does a Low Lactose Diet work ?

When milk is suspected of causing an allergic reaction, it is the protein part of it which is the culprit. For some reason, still not understood, the immune system of some people reacts to milk protein in the diet causing the symptoms mentioned above. In some cases, even the tiniest amount of milk protein can trigger a reaction. The diet must therefore be kept to very strictly. When the problem is lactose intolerance, the gut cannot digest lactose. It then stays within the bowel. Water is drawn into the bowel to dilute the lactose, and the result is bloating and watery diarrhoea. Cutting back the intake of lactose to the point at which the bowel can cope with it will eliminate the symptoms.

What does a Low Lactose Diet involve ?

For milk protein allergy and intolerance, ALL sources of cow’s, goat’s sheep’s and buffalo milk must be excluded from the diet. As so many manufactured food contains milk as an ingredient, it is essential to check the label. Milk ingrediebnts to avoid include milk solids, non-fat milk solids, skimmed milk powder, milk powder, cream (including artificial varieties), cheese, yoghurt, margarine, butter, lactose, whey, hydrolysed whey sugar, casein, caseinate and hydrolysed casein. It is essential to get advice from a dietitian, as the diet can be difficult to follow. It could be nutritionally inadequate leading to other health problems. A lactose-free diet is less restrictive. It involves cutting down most of the foods listed above until symptoms subside. However, some foods which contain milk protein are low in lactose and therefore allowed in the diet e.g. most cheeses, some coffee whiteners and lactose-reducd milks, including soya milk. It is very important to check for non-food sources of milk and lactose. Tablets and other forms of medication often include lactose as a « filler » and could cause problems.

What to watch out for with a Low Lactose Diet

As milk is a major part of most people’s diet, cutting it out can have a detrimental effect on nutrition. In adults, the biggest risk is calcium deficiency. This could lead to thin bones (osteoporosis) This risk can be overcome if calcium enriched foods and soya milk are consumed. Do check with your dietitian to be sure that your calcium intake is adequate: calcium supplements may be advised. In children, an unsupervised milk-free diet can result in many more nutritional deficiencies, including calcium, some vitamins and calories.. This can lead to poor growth and also bone problems. It is essential that the help of a paediatric dietitian is sought. There are prescribable milk protein-free infant formulas available. These are often used up to age three and beyond to keep a good balance of nutrients.

What if a Low Lactose Diet is not followed ?

If a true milk protein intolerance or lactose intolerance is diagnosed, then not following the diet is likely to make the symptoms worse again. Discuss with your doctor or dietitian about reintroducing foods back into the diet as the child gets older, or in lactose intolerance as the gut recovers from its illness.